Provider Demographics
NPI:1376640128
Name:KINGS BAY PHARMACY
Entity Type:Organization
Organization Name:KINGS BAY PHARMACY
Other - Org Name:DOD KINGS BAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA POSC
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:881 USS JAMES MADISON RD BLDG 1028
Mailing Address - Street 2:NAVSUBASE
Mailing Address - City:KINGS BAY
Mailing Address - State:GA
Mailing Address - Zip Code:31547-2531
Mailing Address - Country:US
Mailing Address - Phone:912-673-4264
Mailing Address - Fax:912-673-3761
Practice Address - Street 1:881 USS JAMES MADISON RD BLDG 1028
Practice Address - Street 2:NAVSUBASE
Practice Address - City:KINGS BAY
Practice Address - State:GA
Practice Address - Zip Code:31547-2531
Practice Address - Country:US
Practice Address - Phone:912-673-4264
Practice Address - Fax:912-673-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2020385OtherPK